Fla. Admin. Code Ann. R. 59H-1.0055 - Hospital Participation

(1) The Agency's Financial Analysis Unit shall determine and certify by August 31 of each year, those hospitals that meet the charity care obligation as defined in subsection 59H-1.0035(10), F.A.C., based on audited actual experience for the hospital's fiscal year ending within the preceding calendar year. Hospital eligibility is determined annually for the coming county fiscal year.

(2) Those hospitals that meet the charity care obligation may elect to become participating hospitals as defined in subsection 59H-1.0035(29), F.A.C., if the hospitals:

(a) Have a signed formal agreement with a county or counties to treat indigent patients, or

(b) Have at least 2.5 percent of its uncompensated charity care generated by out-of-county patients, as attested by the hospital. For purposes of this section, out-of-county patients shall include non-Florida residents.

(3) Those hospitals that meet the charity care obligation but are not eligible under paragraph 59H-1.0055(2)(a), F.A.C., must provide annually to the Agency's Financial Analysis Unit by July 31 the following information in the format prescribed by the Agency in order for the Agency to determine the amount of out-of-county uncompensated charity care:

(a) Patients by identification number;

(b) City and county of residence for each patient;

(c) Amount of the bill for each patient;

(d) Amount written off as charity care;

(e) Date written off as charity care; and,

(f) Criteria accepted by the hospital for verification of residency as provided by a statement signed by the patient or the patient's legal guardian or designated representative attesting to the patient's county of residence.

This information shall be for the same period as the period of the hospital's last fiscal year ending within the preceding calendar year. The Agency's Financial Analysis Unit shall certify by August 31 of each year, those hospitals that meet out-of-county requirements as specified in paragraph 59H-1.0055(2)(b), F.A.C.

(4) Teaching hospitals that meet the charity care obligation are eligible for participation as regional referral hospitals.

(5) Subsequent to the initial determination of hospital participation, the Agency's Financial Analysis Unit shall determine the hospital's eligibility annually following submission of the hospital's audited actual experience. The Agency shall annually distribute by September 15, update and annotate a list of participating hospitals and regional referral (or teaching) hospitals to all counties. If, after a hospital has been determined eligible pursuant to subsection 59H-1.0055(3), F.A.C., the Agency's Financial Analysis Unit finds that the hospital incorrectly reported information used to verify having met its charity care obligations and that based on accurate data the hospital was not eligible to participate, then the hospital's eligibility shall be rescinded pursuant to the Administrative Procedures Act, Chapter 120, F.S. The hospital shall also repay to the county any amounts paid to the hospital based upon the erroneous certification of eligibility.

(6) The county shall not be liable for payment of treatment of a certified resident who is a qualified indigent patient or spend-down provision eligible patient, until the Agency's Financial Analysis Unit has determined that the hospital has met its charity care obligations.

(7) The county shall not be liable for payment of treatment of a certified resident who is a qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has documented to the Agency that the hospital has met its obligation to be able to provide the necessary information to the counties required to calculate the rate of reimbursement.

(8) Timely reimbursement to the counties is required, as applicable, pursuant to subsection 59H-1.010(4), F.A.C.

(9) The county shall notify the Agency of any hospital which has met the charity care obligation and with which the county has a formal signed agreement, within 30 calendar days of the effective date of the agreement. If the due date falls on a weekend or holiday, the deadline is the next business day.

(10) The name, title, address, and phone number of the person(s) which shall determine eligibility and process claims on behalf of the hospital shall be provided to the Agency on an annual basis each fiscal year, and when modified. The hospital is responsible for informing the Agency of any changes in this information within 30 calendar days of such change. The Agency shall provide such information to the counties on an annual and modified basis. In the event the hospitals that meet the charity care obligation do not so designate, the Agency shall assume that it is their election to not participate in the HCRA program.

Notes

Fla. Admin. Code Ann. R. 59H-1.0055

Rulemaking Authority 154.3105 FS. Law Implemented 154.31 FS.

New 3-29-89, Amended 12-24-90, 2-24-92, Formerly 10C-26.005, Amended 6-7-00, Amended by Florida Register Volume 42, Number 154, August 9, 2016 effective 8/25/2016.

New 3-29-89, Amended 12-24-90, 2-24-92, Formerly 10C-26.005, Amended 6-7-00, 8-25-16.